Future studies will examine if PDA occurs in other clinical populations.
Pathological demand avoidance (PDA) is a behavioural profile associated with apparently obsessive non-compliance, distress, and florid challenging and socially inappropriate behaviour in children, adolescents and adults (Newson et al. PDA is associated with a passive early history over the first year of development; avoidance of demands, with extreme outbursts if demands are escalated; surface sociability but apparent lack of sense of social identity; lability of mood and impulsivity; comfort in role play and pretending; language delay, possibly attributable to passivity; obsessive behaviour; and soft neurological signs (awkwardness, clumsiness, dyspraxia and similar) (Newson et al. Some propose a terminological move from ‘pathological’ to ‘extreme’ demand avoidance.
Irrespective of underlying drivers, there is little doubt individuals with PDA sometimes present with very problematic behavior, including aggression, socially maladaptive behaviours, and, commonly, educational placement breakdown (O’Nions et al. Anecdotal reports suggest parents and teachers of persons with PDA-like behaviour struggle to manage unpredictable and volatile behaviour.
While one study found that PDA in the context of ASD reduces from child to adulthood (Gillberg et al. Research on PDA has not yet considered adult populations, partly because no reliable tool has been available for use in systematic studies of these features in adults.
Furthermore, research has shown that children with a diagnosed attachment disorder may be as impaired as autistic children in their social relatedness and language skills (Sadiq, et al., 2012), and one study found that the symptoms of ASD and attachment disorder can be comorbid (Giltaij, et al., 2015). Journal of Intellectual Disability Research, 59(2), 138–149.
Therefore, given that PDA is currently considered a form of ASD, it is fair to assume that a similar overlap in symptoms may exist between PDA and attachment disorders. Impulsivity and immediate mood changes were also reported more in individuals with PDA, whereas individuals with ASD were noted to lack impulsivity and adhered to routine.Recent work in individuals with ASD and problem behavior suggests a robust correlation between non-compliance with routine requests and irritability (Chowdhury et al. Also differentiating ASD and PDA, there is some evidence to show individuals with PDA show good imagination and role-playing [although reports of observed behaviour suggest this often involves mimicking characters and stories rather than introducing novelty (O’Nions et al. PDA is informally recognised by some practitioners and some service-user groups in the UK and beyond, but has remains controversial.sensory sensitivities, phobias, need for predictability/sameness, perception of routine requests as aversive (Lucyshyn et al. This work observed that persons with PDA reject demands through a variety of social strategies, such as distraction or negotiation, whereas individuals with ASD tend to be more forthright and direct, so less strategic or ‘manipulative’ in their rejection of demands.Given the concept of autism has broadened to include a wider range of phenotypes, social methods of distraction are likely to be seen across a broader cross section of the autism spectrum.Only a short while ago, PDA (pathological demand avoidance) was a term little known to the public; however, due to an increased presence in social media, PDA is becoming a household term.It is not surprising, therefore, that services are under increasing pressure to consider PDA as a diagnosis.Study 2 (n = 191) found low agreeableness, greater Emotional Instability, and higher scores on the full ASQ predicted EDA-QA.PDA can screened for using this tool, occurs in the general population, and is associated with extremes of personality.Professor Elizabeth Newson (founder of the term PDA) and her colleagues suggest that PDA accurately describes a group of children who, similarly to children on the autistic spectrum, present with difficulties in social communication, relationships and use of language, as well as displaying rigidity and obsessive behaviour.However, they highlight a few key, but important differences between PDA and ASD.